SLR - October 2019 - Karen Fischborn
Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm
Reference: References Lee, Z., Stranix, J., Rifkin, W., Daar, D., Anzai, L., & Ceradini, D. et al. (2019). Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm. Plastic And Reconstructive Surgery, 144(3), 759-767. doi: 10.1097/prs.0000000000005955
Scientific Literature Review
Reviewed By: Karen Fischborn, DPM
Residency Program: Palmetto General Hospital – Hialeah, FL
Podiatric Relevance: Prior to the 1990s traumatic lower extremity injuries were treated with free flap coverage. However after the introduction of negative pressure therapy, its use diminished. Recently many authors have revisited the free flap principle and microsurgical practices, stating that they are more successful and have more favorable outcomes. It is important for the podiatric community to have various ways of healing traumatic wounds. This study focuses on revisiting the Godina Paradigm to be able to assess any changes to it.
Methods: Three hundred and fifty-eight patients were retrospectively reviewed who had a soft-tissue free flap after below knee trauma from 1979-2016. All patients had surgical intervention within one year of injury. Patients were then put into three categories based on timing between injury and intervention: three days or less (early), four to 90 days (delayed), more than 90 days (late). The delayed group was split into two subgroups: four to nine days and 10-90 days.
Results: Flaps performed within the early group had a decreased risk of major complications than those in the delayed group. However when those in the early group were compared to those in the delayed subgroup (four to nine days), there was no significant difference. On the other hand when the two subgroups in the delayed group were compared the four to nine day had significantly lower total failures and complications than the 10-90 day subgroup.
Conclusions: The early group had better outcomes when compared to the delayed group. However when comparing the subgroups in the delayed group, the four to nine day group still had significantly lower complications and failure rates. Godina paradigm explained that the safe period for free flaps was less than 72 hours after the injury, this study explains that this window can safely be extended to 10 days.